Temporomandibular disorders have had controversies in their management for decades. However, a network meta-analysis suggests a paradigm shift in management, recommending minimal invasive management as the first line due to the limited improvement with conservative therapies and the good results with arthroscopy (Al-Moraissi et al., 2020). Also, articular disc displacement has been widely discussed in the temporomandibular joint (TMJ) literature. Although many patients do not require invasive procedures for its reduction, many others do require surgery for disc repositioning and fixation. To perform discopexy, multiple options have been described based on open or arthroscopic techniques. A recent systematic review found that both techniques achieve good results in improving pain and oral opening (Askar et al., 2021). However, considering that the arthroscopic technique could be more beneficial due to its minimal invasive nature, it should be studied more.

Onishi in 1975 introduced diagnostic arthroscopy for the management of temporomandibular disorders (Ohnishi, 1975). Subsequently, Sanders found therapeutic utility in TMJ pathology by performing lysis and lavage (Sanders, 1986). Today, arthroscopic disc repositioning (ADR) refers to a group of surgical maneuvers that bring the articular disc to a more anatomical and functional position. Multiple arthroscopic discopexy techniques and modifications of these techniques have been described over time to fix the disc in the best position. One of the reported techniques suggests fixation of the disc to the lateral soft tissue adjacent to the joint (McCain et al., 1992a, McCain et al., 1992b). Some other techniques propose disc fixation to the condyle using anchors or resorbable pins. These techniques allow fixation of the disc to a more rigid structure and prevent lateralization of the disc due to its final position (Martín-Granizo and González-García, 2022). Additionally, other authors have proposed fixing the disc to the tragus cartilage based on finding a more physiological position and traction vector for the disc (Yang et al., 2012). However, each technique has its own difficulty and, likewise, different equipment and instruments are required for its implementation. It is also for this reason that different modifications of the main techniques have been described to make it easier for each clinician to perform arthroscopic discopexy (Del Santo et al., 2023; Jerez et al., 2022). However, to date, no studies have been carried out that compare current techniques and evaluate which has the best clinical results for patients.

This systematic review aims to evaluate which of the main arthroscopic discopexy techniques has the best clinical results evaluated in terms of pain and maximum interincisal opening in patients with TMJ internal derangement. The hypothesis of the present study was that all disc fixation techniques have the same probabilities of improving symptoms.